title: Melanoma in primary care. The role of the general practitioner.
abstract: BACKGROUND
  The British Association of Dermatologists and the National Cancer Control Programme in Ireland discourage all GPs from biopsying any lesions suspicious of melanoma.
  
  
  OBJECTIVE
  The aim of this study was to assess whether or not it is safe and practical for a general practitioner with extra training in dermatology and skin surgery to assess suspicious skin lesions and treat low risk melanomas.
  
  
  METHODS
  The outcome of 56 new melanomas (31 invasive, 7 in situ and 18 lentigo maligna) in 53 patients, managed by a GP with extra training in dermatology and skin surgery, over a 20 year period, was examined.
  
  
  RESULTS
  Forty-eight (86 %) of the melanomas had the initial biopsy carried out in primary care. The average time from presentation to the practice to the date of the biopsy was 8 days for the in situ and invasive melanomas and 17 days for the lentigo malignas. Twenty-eight (50 %) of the melanomas were considered low risk (in situ, invasive <1 mm deep or lentigo maligna) and were treated successfully in primary care according to the Australian and New Zealand guidelines, without any surgical complications.
  
  
  CONCLUSIONS
  GPs with extra training in skin cancer and skin surgery could assess most suspicious skin lesions with dermoscopy and if necessary, biopsy most of these lesions in primary care. This would lead to a quicker diagnosis, more rapid pathway to definitive treatment, lower cost and more convenience to the patient, especially for those living in rural areas.
authors.affiliation: The Ashe Street Clinic, Tralee, Co Kerry, Ireland, info@asctralee.com.
authors.forename: D
authors.initials: D
authors.lastname: Buckley
authors.forename: C
authors.initials: C
authors.lastname: McMonagle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis; D002983:Clinical Competence; D046169:Dermoscopy; D005260:Female; D058005:General Practitioners; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000175:diagnosis / Q000473:pathology; D007494:Ireland; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D018328:Melanoma, Amelanotic / Q000175:diagnosis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010819:Physician's Role; D011320:Primary Health Care; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult